On this page
- Key messages
- Notification requirements for Candida auris
- Primary school and children’s services centre exclusion for Candida auris
- Infectious agent
- Identification of Candida auris
- Public Health significance of Candida auris infection and colonisation
- Mode of transmission of Candida auris
- Period of communicability of Candida auris
- Risk factors for Candida auris infection in Australia
- Control measures for Candida auris in health care
- Further information
- Contacts
Key messages
- Candida auris (C. auris) is an urgent notifiable condition. Pathology services must notify cases to the Department of Health immediately upon initial diagnosis.
- C. auris is an uncommon fungus that can cause serious infections such as bloodstream and wound infections, particularly in those who are immunocompromised or have other underlying medical conditions.
- People can carry C. auris without having illness and transmit it to others.
- C. auris can also cause problems in hospitals and nursing homes as it can spread from one patient to another or from shared objects or the environment.
- C. auris is often resistant to antifungal medicines, making it very difficult to treat.
- C. auris can be difficult to identify in laboratories without specialised testing.
Notification requirements for Candida auris
C. auris is an ‘urgent’ notifiable condition and must be notified by pathology services immediately to the Department of Health by telephone on 1300 651 160 (24/7) upon initial diagnosis (suspected or confirmed). Pathology services must follow up with written notification within 5 days. This is a Victorian statutory requirement.
All isolates of suspected or confirmed C. auris must be referred by pathology services to the Victorian Infectious Diseases Reference Laboratory (VIDRL) for further confirmatory or susceptibility testing.
Primary school and children’s services centre exclusion for Candida auris
School exclusion is not required.
Infectious agent
C. auris is a fungus which is part of the Candida species. It can cause a range of invasive infections and has been isolated from a range of body sites, including the skin, gastrointestinal tract, urogenital tract and respiratory tract.
Unlike other fungal pathogens, C. auris can be transmitted between people and has been associated with healthcare-associated outbreaks internationally. Although uncommon in Australia, C. auris is considered an emerging multi-drug resistant organism that is a significant public health threat.
Identification of Candida auris
Clinical features
People can be colonised with C. auris without having symptoms. Colonisation generally occurs on the skin, the gastrointestinal tract, urogenital tract or around indwelling medical devices (such as PEG tubes and central lines).
Invasive C. auris infection can present as sepsis, urinary tract infections, wound infections, ear infections or line infections. C. auris sepsis has a case fatality rate between 30 to 60 per cent, similar to other invasive Candida species infections. Most people with invasive infection have other co-morbidities.
C. auris infections can be more difficult to treat than other Candida infections due to antimicrobial resistance. It can also spread more easily to other patients.
Diagnosis
C. auris infection or colonisation is diagnosed by isolating the fungal pathogen on culture.
Clinicians and laboratories should be aware of the possibility of C. auris, especially in high-risk patients who have cultured non-albicans Candida species. Any suspected or confirmed isolates of C. auris must be referred to VIDRL for further confirmation, antimicrobial susceptibility and molecular testing.
Public Health significance of Candida auris infection and colonisation
C. auris is a major public health concern for the following reasons:
- It can cause serious infections such as bloodstream infections and potentially lead to death. More than one in three patients with invasive C. auris infection (for example, an infection that affects the blood, heart, or brain) die.
- It is often antimicrobial resistant. C. auris is often not susceptible to antifungal medicines that are commonly used to treat Candida species infections. Some C. auris infections have been resistant to all three major classes of antifungal medicines.
- Incidence of C. auris infection and colonisation has been increasing around the world. C. auris was first described in 2009, it has spread quickly and caused infections or facility outbreaks in more than a dozen countries.
- It is difficult to identify. C. auris can be misidentified as other types of fungi unless specialised laboratory technology is used which can lead to delays in appropriate treatment being commenced.
- It can spread in hospitals and nursing homes. C. auris has caused outbreaks in overseas healthcare facilities and can spread through person-to-person transmission and contaminated surfaces or shared equipment. C. auris can live on surfaces for several weeks.
Mode of transmission of Candida auris
C. auris can spread in healthcare settings through contact with contaminated environmental surfaces or equipment, or from person to person.
Good hand hygiene and cleaning in healthcare facilities is essential to reduce transmission. More research is needed to understand why it spreads more rapidly and cause more outbreaks than other Candida species.
Period of communicability of Candida auris
People who are colonised or infected with C. auris are considered to be colonised indefinitely and must be placed in contact precautions during all future hospital admissions.
Risk factors for Candida auris infection in Australia
International travel to affected areas (such as the UK, India, Pakistan, China, South Africa and parts of the USA) creates an increased risk of spread of C. auris to Australia. Admission to healthcare services or residential care in these areas is a particularly significant risk factor for C. auris colonisation.
It is important to know that people may carry C. auris on their skin without any symptoms; these individuals are at risk of getting C. auris infection if they are hospitalised for another reason. C. auris is more likely to affect patients who have:
- A hospital stay in an area with documented or suspected C. auris transmission
- A prolonged hospital stay
- An indwelling medical device, such as a central venous catheter, urinary catheter, biliary catheter or wound drain
- An impaired immune system
- Multiple or recent exposures to broad spectrum antibiotics
- Diabetes mellitus
- Recent surgery
Australia has reported very few cases of C. auris to date which is due in part to our geographic isolation. However, the risk of C. auris spreading to Australia is recognised as an emerging and high risk public health issue.
Control measures for Candida auris in health care
Control of cases
Treatment is the responsibility of the treating clinician with advice from an infectious diseases specialist.
Infection control precautions for hospitalised patients with C. auris include care in a single room and contact precautions. These should be instituted every time a person with a history of C. auris colonisation or infection is admitted to a healthcare facility until discharge (even if screening specimens taken at the time of admission are negative for C. auris).
Until further evidence to the contrary is available, the current advice for the use of infection control precautions is that once a person is identified as a case of C. auris, they should be considered potentially infectious indefinitely.
Clinicians referring a patient with a history of C. auris infection or colonisation to hospital, including outpatients/consultant rooms or the Emergency Department, please make sure the hospital is informed.
Control of contacts
Early detection of C. auris through targeted patient screening is essential to enable containment. Therefore, as cases are detected in Victoria there will be targeted contact tracing measures undertaken for patients who may have been in contact with the case during hospital admissions.
The use of standard and contact precautions, including effective hand hygiene, reduces the risk of transmission between patients.
Outbreak measures for Candida auris
Given the low case numbers in Australia and the public health significance of the organism, every identified case in a health service or long-term residential care is considered an outbreak.
Swift case and contact control actions must be undertaken for each case as described above.
Further information
Further information for clinicians, health care facility staff, patients, and visitors and screening can be found in the Victorian guideline on C. auris for health services.
Further consumer information is available on the Better Health .
Additional information is available here:
Contacts
For more information please contact the Communicable Disease Prevention and Control section at the Department of Health on 1300 651 160.
Reviewed 05 October 2023